We're glad you want to join a CORE Group! Please tell us a little about yourself so that we can match you up to the group that best fits you!
Name
*
First Name
Last Name
Cell Number
*
Please enter a valid phone number.
Birthdate
*
-
Month
-
Day
Year
Date
Email
*
example@example.com
Spouse Name
First Name
Last Name
Spouse Cell Number
Please enter a valid phone number.
Spouse Email
example@example.com
Birthdate
-
Month
-
Day
Year
Date
Do you have a location preference?
Petal
Richton
Hattiesburg
Longleaf
Do you have kids living at home?
YES
NO
If YES, what are their ages?
0-4 years
5-8 years
9-12 years
13-17 years
Are you interested in hosting a CORE Group?
YES
NO
Submit
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